How is umbilical endometriosis managed?

Management of Umbilical Endometriosis

Surgical excision is the treatment of choice for umbilical endometriosis, providing both diagnostic confirmation and therapeutic benefit with a low risk of recurrence. 1

Diagnosis and Clinical Presentation

• Umbilical endometriosis accounts for 0.5-1% of all extra-pelvic endometriosis cases and presents with characteristic features 1, 2:

  • Brown to dark nodule in the umbilicus
  • Cyclical pain during menstruation
  • Umbilical swelling
  • Catamenial bleeding from the umbilical lesion

• Diagnosis should be based on clinical symptoms and confirmed by histopathological examination 3, 1

• Imaging studies such as ultrasound and MRI can help assess the extent of the lesion and rule out multifocal involvement 1, 4

Treatment Algorithm

First-Line Management: Surgical Approach

• Complete surgical excision with free margins is the gold standard treatment for umbilical endometriosis 1, 5, 2

  • For small lesions: Local excision preserving the umbilicus 5
  • For larger lesions: Complete omphalectomy (removal of the entire umbilicus) may be necessary 6

• Laparoscopically-assisted approach may be beneficial, especially for:

  • Recurrent cases
  • Cases with suspected intra-abdominal involvement
  • More extensive disease 6

• Surgical excision provides:

  • Definitive histological diagnosis
  • Complete resolution of symptoms
  • Good aesthetic results
  • Low recurrence rates 6, 2

Second-Line/Adjunctive Management: Medical Therapy

• Medical management may be considered as adjunctive therapy following surgical excision 3, 7:
  • NSAIDs for pain management 3, 7
  • Hormonal therapies:
    • Oral contraceptives 3, 7
    • Progestins (oral or depot medroxyprogesterone acetate) 3, 7
    • GnRH agonists (for at least three months) with add-back therapy to prevent bone mineral loss 3, 7

Post-Treatment Follow-Up and Outcomes

• Recurrence rates after surgical excision are relatively low, with anatomical recurrence reported in only 5.4% of cases 2

• Symptom recurrence occurs in approximately 27% of patients, with a lower rate observed in those receiving post-operative hormonal therapy 2

• Patient satisfaction rates following surgical treatment are high (83.8%), confirming surgical excision as the preferred approach 2

Important Considerations and Pitfalls

• Umbilical endometriosis can be either primary (spontaneous) or secondary (following surgical procedures) 1, 5

• Concomitant pelvic endometriosis is present in approximately 66% of umbilical endometriosis cases, warranting consideration of further evaluation 2

• Superficial treatments (such as diathermocoagulation) should be avoided as they predispose patients to disease relapse 6

• Post-operative hormonal therapy should be considered to reduce the risk of symptom recurrence 2

• Long-term follow-up is recommended to monitor for potential recurrence 6, 2